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General NPI Number Information
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NPI Number | 1649183542
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Entity Type | Individual
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Provider Name | MARTI JO WHITEHEAD RN
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Gender | Female
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Dates
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Enumeration Date | 09/23/2026
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Last Update Date | 09/23/2026
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Provider Practice Location Address
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Address Line | 5603 KERSEY LN
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City | JONESBORO
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State | AR
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Zip | 72404-8804
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Country | US
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Telephone | 870-931-2668
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Fax | 870-935-6203
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Provider Business Mailing Address
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Address Line | 5603 KERSEY LN
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City | JONESBORO
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State | AR
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Zip | 72404-8804
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Country | US
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Telephone | 870-935-6200
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Fax | 870-935-6203
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R063415
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License Number State | AR
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